妊妇上吐下泻，胎动欲堕，腹疼难忍，急不可缓，此脾胃虚极而然也。夫脾胃之气虚，则胞胎无力，必有崩坠
之虞。况又上吐下泻，则脾与胃之气，因吐泻而愈虚，欲胞胎之无恙也得乎！然胞胎疼痛而究不至下坠者，何也？
全赖肾气之固也。胞胎系于肾而连于心，肾气固则交于心，其气通于胞胎，此胞胎之所以欲坠而不得也。且肾气
能固，则阴火必来生脾；心气能通，则心火必来援胃，脾胃虽虚而未绝，则胞胎虽动而不堕，可不急救其脾胃乎！
然脾胃当将绝而未绝之时，只救脾胃而难遽生，更宜补其心肾之火，使之生土，则两相接续，胎自固而安矣。
方用援土固胎汤。
人参（一两） 白术（二两，土炒） 山药（一两，炒） 肉桂（二钱，去粗，研） 制附子（五分） 续断（三
钱） 杜仲（三钱，炒黑） 山萸（一两，蒸，去核） 枸杞（三钱） 菟丝子（三钱，酒炒） 砂仁（三粒，炒，研）
炙草（一钱）
水煎服。一剂而泄止，二剂而诸病尽愈矣。此方救脾胃之土十之八，救心肾之火十之二也。救火轻于救土者，
岂以土欲绝而火未甚衰乎？非也。盖土崩非重剂不能援，火衰虽小剂而可助，热药多用，必有太燥之虞，不比温甘
之品也。况胎动系土衰而非火弱，何用太热。妊娠忌桂附，是恐伤胎，岂可多用。小热之品，计之以钱，大热之
品，计之以分者，不过用以引火，而非用以壮火也。其深思哉！
眉批∶白术多伪，肉桂更无佳者。用者若有真药固妙，如无真药，白术以白扁豆代之，肉桂以破故纸代之。
歌括∶妊妇吐泻胎不安，腹痛难忍不可缓。
多因脾胃气虚故，温补心肾是真诠。
援土固胎参术药，萸桂杜仲菟丝断。
炙草枸杞砂附子，脾胃气盈胞胎安。
Pregnant women presenting with vomiting and diarrhea, fetal restlessness with a tendency to miscarriage, and unbearable abdominal pain constitute an emergency that cannot be delayed. This is caused by extreme deficiency of the Spleen and Stomach. When the Qi of the Spleen and Stomach is deficient, the Bao Mai (uterus/fetus) lacks support, creating a risk of collapse (miscarriage). Moreover, with vomiting and diarrhea, the Qi of the Spleen and Stomach becomes even more depleted due to these losses; how can the Bao Mai remain safe? However, although the Bao Mai is painful, it does not ultimately descend. Why? This relies entirely on the consolidating power of Kidney Qi. The Bao Mai is connected to the Kidneys and linked to the Heart. When Kidney Qi is solid, it communicates with the Heart, and its Qi reaches the Bao Mai; this is why the Bao Mai tends to descend but does not. Furthermore, if Kidney Qi can consolidate, then Mingmen Fire (Gate of Life Fire) must come to generate Spleen Earth; if Heart Qi can communicate, then Heart Fire must come to assist Stomach Earth. Although the Spleen and Stomach are weak, they are not yet exhausted; thus, although the fetus is restless, it will not miscarry. Should we not urgently treat the Spleen and Stomach? However, when the Spleen and Stomach are in a state of impending exhaustion but not yet gone, merely treating them makes rapid recovery difficult. It is better to supplement the Fire of the Heart and Kidneys to generate Earth, so that the two mutually support each other, and the fetus will naturally become stable and calm. Use Yuantu Gutai Tang (Earth-Supporting Fetus-Stabilizing Decoction).
Ren Shen (Ginseng Radix et Rhizoma) (1 liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (2 liang, stir-fried with soil), Shan Yao (Dioscoreae Rhizoma) (1 liang, stir-fried), Rou Gui (Cinnamomi Cortex) (2 qian, remove rough bark, grind), Zhi Fu Zi (Aconiti Lateralis Radix Praeparata) (5 fen), Xu Duan (Dipsaci Radix) (3 qian), Du Zhong (Eucommiae Cortex) (3 qian, stir-fried until black), Shan Yu Rou (Corni Fructus) (1 liang, steamed, pitted), Gou Qi Zi (Lycii Fructus) (3 qian), Tu Si Zi (Cuscutae Semen) (3 qian, stir-fried with wine), Sha Ren (Amomi Fructus Rotundus) (3 grains, stir-fried, grind), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (1 qian).
Decoct in water and take orally. After one dose, diarrhea stops; after two doses, all symptoms resolve completely. This formula dedicates 80% of its efficacy to rescuing Spleen and Stomach Earth, and 20% to rescuing Heart and Kidney Fire. Why is rescuing Fire lighter than rescuing Earth? Is it because Earth is about to collapse while Fire has not significantly declined? No. It is because Earth collapsing requires heavy doses to rescue, whereas declining Fire can be assisted with small doses. Using too many hot herbs carries the risk of excessive dryness, unlike warm and sweet substances which are milder. Moreover, fetal restlessness is due to Earth deficiency rather than Fire weakness; why use overly hot herbs? Cinnamon Twig (Rou Gui) and Prepared Aconite Root (Fu Zi) are contraindicated in pregnancy for fear of damaging the fetus; how can they be used in large amounts? Small hot substances are measured in qian, while large hot substances are measured in fen; this is merely to guide Fire back to its source, not to bolster excessive Fire. Such profound thinking!
Marginal Note: Bai Zhu is often adulterated, and Rou Gui rarely has good quality. If genuine herbs are available, that is ideal. If not, Bai Zhu can be replaced by Bai Bian Dou (Lablab Seed), and Rou Gui by Po Gu Zhi (Psoraleae Fructus).
Song Verse:
Pregnant woman vomits and purges, fetus uneasy,
Abdominal pain unbearable, no time to delay.
Due to Spleen and Stomach Qi deficiency,
Warming and tonifying Heart and Kidney is the true principle.
Yuantu Gutai uses Ginseng, Atractylodes, and Yam,
Cornus, Cinnamon, Eucommia, Dodder seed, and Teasel root.
Honey-fried Licorice, Lycium fruit, Amomum, and Aconite,
When Spleen and Stomach Qi is full, the Bao Mai is secure.